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Sleep loss and circadian disruption in shift work: health burden and management

Nearly 1.5 million Australians are employed in shift work, representing 16% of the working population. Shift work is associated with adverse health, safety and performance outcomes. Circadian rhythm misalignment, inadequate and poor-quality sleep, and sleep disorders are thought to contribute to these associations.

The most immediate consequence of shift work is impaired alertness, which has widespread effects on core brain functions — reaction time, decision making, information processing and the ability to maintain attention. This impairment leads to preventable errors, accidents and injuries, especially in high-risk environments. Long-term health consequences of shift work have been reported, including increased vascular events.1

This review evaluates the health burden associated with shift work and discusses strategies for the clinical management of sleep–wake disturbances in shift workers. Evidence-based management strategies require consideration of the key physiological sleep–wake determinants of alertness (Box 1).

Circadian and sleep–wake disturbances